A PEG is the term often used for a Percutaneous Endoscopic Gastrostomy tube.

PEG tubes are used to feed a person straight into their stomach if they have a problem feeding by mouth, cannot maintain their weight or are unable to digest food. It can be used either to meet all of their nutritional needs or to supplement the diet.

• Percutaneous means through the skin.
• Endoscopic is the way in which the tube is placed. The patient is sedated, then the doctor or nurse uses an endoscope (a flexible tube used to examine inside the stomach) to guide the placement of the tube.
• Gastrostomy stands for the small incision made in the stomach wall, through which the gastrostomy tube is passed.

PEG tubes can be used either temporarily or permanently. Manufacturer’s guidelines suggest that each tube placed can be used for approximately two years. Liquid feeds are given through the tube either with a syringe or a feeding pump.

Once your incision site (stoma) has completely healed, your stoma should be healthy.

A healthy stoma

• Dry and clean.
• No leakage.
• No redness around the tube.
• No pain on movement.

If you experience pain on feeding, external leakage of stomach contents or fresh bleeding is noted within 72 hours of PEG insertion, stop feeding go to your nearest A&E.

Caring for your PEG tube

Each day you will need to provide the following care for your feeding tube.

Checking position

Get to know which cm marking sits at skin level and monitor this at least daily. It is important the tube does not move. If you notice a different centimetre marking at skin level or the tube moves excessively in and out of the stoma, the tube may have become displaced. If it has moved, please contact your enteral feed company nurse or community nurse for advice.

Cleaning your PEG

• Wash your hands according to your hand hygiene leaflet.
• Gently remove the dressing the day after your procedure.
• Carefully clean daily around the gastrostomy site, under the external fixation device and around the tube with water and a disposable cloth or gauze. Dry well to reduce the risk of soreness and infection. When the site is better established after 14 days it may be cleaned with mild soap and water, and then dried.
• You may have a shower. Cap off the tube and avoid directing water directly at the stoma site. If you choose to have a bath, it is important to avoid soaking the stoma site. Please make sure the water level lies below the stoma site.
• Do not use creams or talcum powder near or around the stoma site to avoid the risk of irritation and avoid breakdown of the tube.
• If the site is dry then no dressing is needed. There may be a small amount of discharge around the stoma for 10 to 14 days. If you are worried about this, please ask your enteral feed company nurse or community nurse for advice.

If you experience any of the following symptoms it could indicate the site is infected:

• oozing or odour coming from the stoma site
• redness
• soreness
• raised area
• you have a temperature or feel unwell.

 Please contact your GP, enteral feed company nurse or community nurse for advice.

Rotating and advancing your tube

It is important to rotate and advance the PEG to prevent the tube sticking to the stoma tract and embedding in the stomach wall.

Rotation

On day 14 rotate the tube through a full circle (360°) daily, this is to help develop the stoma tract.

Advancement

Do not move the external fixation plate for the first 14 days to allow the stoma tract to heal. On day 14, the external fixation plate can be moved away from the body and the tube advanced 2cm into the stoma at least once a week. Return the external fixation plate to its original position of 0.5 to 1cm away from the skin.

If you cannot advance or rotate your PEG tube, stop using the tube and seek advice from your enteral feed company nurse, GP or HEN Team. It is important you report any problems as it could lead to a complication called buried bumper syndrome which could result in an hospital admission.

Flushing your PEG

If you are not using your gastrostomy tube for feeding, please make sure you flush the tube at least once a day with fresh tap water to prevent the tube from blocking. Please contact your dietitian to advise you on the amount required.

Method 

• Wash your hands according to the hand hygiene leaflet.
• If you are caring for someone, apply gloves and an apron.
• Place all the equipment you require on a clean surface, such as 60mls syringe and measured water in a jug or
• Check the position of the feeding tube has not moved by checking the skin level centimetre marking.
• Complete either of the instructions below:

1. Remove the cap from the end of your PEG.
2. Remove the plunger from the syringe and attach it to your feeding tube.
3. Use your syringe as a funnel to slowly pour the correct amount of water into your feeding tube, keeping the syringe higher than the stoma site.
4. Remove the syringe and recap your tube.

or

1. Draw up the required amount of water into your syringe.
2. Remove the cap from the end of your PEG.
3. Attach the syringe to your PEG and slowly press down the plunger in the syringe to flush water into the tube.
4. Remove the syringe and recap your PEG.

• When flushing your tube, try to avoid emptying the tube completely by closing the clamp before all the water has gone through. If you do not do this air can enter your stomach and make you feel uncomfortable and bloated.
• Try to remain upright for at least 30 minutes after a feed or flush to reduce the risk of reflux and regurgitation.
• Clean the syringe and store as advised.